EMDR

Shame is one of the most difficult feelings for humans to acknowledge and express. It becomes a vicious circle: We feel shame about an event or action in our lives, and then feel shame about our shame. Shame causes self-doubt, depression and deep suffering and prevents us from living freely, fully and authentically. Our shame causes us to monitor what we say and do, out of fear of saying or doing the “wrong thing.”

As a humanistic, existential and Buddhist psychotherapist, my primary goal is to help my clients uncover the truth about the cause of their suffering so that they can live full and satisfying lives. Through my work with a client I will call “Bill”, I have discovered the power of EMDR[i] as a tool in this process.

Bill came to see me complaining that he was not able to experience joy or passion in his life, and felt that nothing he was doing had any meaning. This is an apt description of existential despair. Bill had not suffered any recent crises that would account for his angst, and on the surface, his life looked quite successful: Bill is a brilliant scientist, in a good marriage and has a high paying job. He is athletic and is an avid cyclist and skier. However, Bill was unable to experience any joy, passion or satisfaction from his accomplishments and activities, saying that he had a “nagging feeling that something is missing.”

Bill and I spent many sessions trying to identify the source of his existential despair. He described growing up in a small mid-western town. His parents divorced when he was 16 years old, and he and his brother lived with his father. Bill has been estranged from his mother for over 20 years. He described his mother as having an “alternate lifestyle” as a Lesbian and artist. It was clear to me that he was doing what we therapists call “splitting” – seeing his father as all good, and his mother as all bad. However, my attempts to go there with him were futile.

Bill tended to describe painful experiences, like the recent death of a friend and his parents’ divorce, intellectually, factually and with little emotion. My attempts to go deeper would be met with the response “I don’t know”. After several months together, Bill acknowledged a deep fear of expressing his emotions, saying, “what if I express myself and no one accepts it?” Attempts to explore his fear more deeply were met at that point with more “I don’t knows” and intellectualizing. I observed how difficult it was for Bill to directly experience his body sensations and emotions. He acknowledged that he has always relied on his intellect as a way to cope.

In addition to Bill’s fear of rejection if he expresses himself, he came to realize his deeply held belief that “If I were a good enough person, my life would have more meaning and joy.” We explored what this meant to him, and I asked Bill what unfinished business he might need to complete, and what he would need to accomplish if he had a terminal diagnosis – the big existential question. It was clear to me that his estrangement from his mother was the elephant in the room, but Bill was unable or unwilling to go there at that point in our therapeutic relationship. I believed then that EMDR (see footnote 1) would help forward Bill’s journey of self-discovery. Bill agreed to give it a try.

Our first task in preparing Bill for EMDR was to get him to feel safe feeling his body sensations and emotions, and our next task was to identify a target for our EMDR work. He identified the target as his fear of being emotional, and described the incident representing the worst part of this issue as being rejected by a girl in elementary school after he gave her a gift. The negative belief he took from that experience was “I will get hurt if I express my feelings”, and the positive belief he wanted to have instead was “I am safe to express myself.” Bill was able to complete the work on this target in one session. However, we both came away with the feeling that there was something more. I encouraged Bill to note any insights and new memories that might arise during the week before I saw him again.

Bill came in the following week saying that after our EMDR session, he started experiencing profound shame about his parents’ divorce and his feelings about his mother’s lifestyle. We discussed how painful shame is, and I validated his difficulty in acknowledging it.

My experience as a therapist, and as a former client in therapy, has taught me how unbearable the experience of shame can be. We will do almost anything to avoid it – risky behaviors, blaming others, acting out in any number of ways. Shame unacknowledged can lead to deep depression as a result of internalizing the negative messages we received earlier in life. In acting out his shame, Bill made his mother the “bad guy” and was unable to take pleasure in his life, a form of self-punishment. He had internalized his family rules “don’t air our dirty laundry” and “don’t express your feelings” to such an extent that he was living an inauthentic life, leading to his existential despair. Bill’s fear of feeling the full panoply of life’s emotions resulted in his dissatisfaction and belief that his life lacked meaning.

Bill’s nascent awareness of his shame placed him in what Naranjo (1993, pp. 52, 63) has called “a limbo where the surface games of the personality have been dropped and self-awareness has not [yet] taken its place. Shame… [is] not [a] pure experience[] of reality, but the outcome of attitudes in which we stand against that reality, denying or resisting it, fearing to perceive it….Shame [is a] mind-created curtain that we interpose between ourselves and the world.” [ii] This curtain of shame prevents us, like Bill, from fully and directly experiencing life and all of its riches, whether painful or pleasurable.

Bill asked to do another EMDR session around this issue. The negative belief he has carried about his shame was “I am insignificant” and the positive belief he wanted to have instead is “I matter.” The emotions that he felt were grief, despair and shame. Through the EMDR process, Bill discovered that he has spent an inordinate amount of time trying to avoid his feelings and be “perfect”, and that he projected his shame on his mother and others who he perceived as not good enough. He also felt tremendous guilt about the way he treated his mother. After processing the disturbing feelings, Bill discovered that truest positive belief for him was “I forgive myself.” This was a deeply moving session for both of us.

Bill came in to our next session saying that he felt that our work was complete for the time being. He said that he had blamed his mother for everything, in his black and white thinking, and was in the process of writing a letter to her to acknowledge this and hopefully begin a relationship with her. Bill said he had a tremendous sense of relief about this, and he felt more appreciation for his life. I encouraged Bill to use “I forgive myself” as his mantra when he felt the tendency to retreat behind his curtain of shame. Bill knows that he is on the path to continued healing, and, with his newly gained tools, is not afraid or ashamed to meet the challenges that lie ahead.

[i] EMDR is a scientifically proven therapeutic protocol for overcoming trauma and other life difficulties. EMDR utilizes “bilateral stimulation”, i.e., sensory stimulation alternately on both sides of the spinal cord to release traumatic material from the brain in a way that makes it workable. Trauma that is locked in the brain leads to the “fight, flight or freeze” response. EMDR helps release traumatic images, transforming them into memories that no longer have a deleterious hold on the individual. In addition to this physiological response to trauma, the traumatized individual also develops negative beliefs about him or herself (such as “I do not deserve love, “I was at fault,” etc). EMDR allows the individual to replace negative cognitions about him or herself with positive ones (such as “I deserve love”, “I did the best I could”, etc.). EMDR also works on a somatic level, with the therapist guiding the client to feel the traumatic images and negative beliefs in the body, thus further facilitating the transformation of the images into non-intrusive memories, and also transforming the negative beliefs into positive, useful ones. Therapists need to be trained to practice EMDR, and follow a standardized protocol in EMDR work with clients. (The foregoing is a brief summary of EMDR, and is not intended to be a full explanation of the process.)

The intense and painful experiences of grief are generally considered “normal.” However, when those experiences are extremely distressing, unduly interfere with day-to-day functioning or do not subside to a manageable level over time, the bereaved may be experiencing complicated or traumatic grief. Complicated grief has been proposed as a new diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders (DSM), and suggested components of the diagnosis include (1) that sufferers experience bereavement by death; (2) that their reactions include intrusive and distressing symptoms, including yearning, longing and searching for the deceased; and (3) that the bereaved exhibit at least four marked and persistent trauma reactions, which may include: “avoidance of reminders of the deceased, purposelessness, feelings of futility, difficulty imagining a life without the deceased, numbness, detachment, feeling stunned, dazed or shocked, feeling that life is empty or meaningless, feeling a part of oneself has died, disbelief, excessive anger or bitterness related to the death, and identification symptoms or harmful behaviors resembling those suffered by the deceased” (Mitchell et al, 2004, p. 13).

Even in cases that do not fit the criteria for complicated grief as described above, the events surrounding the death may be sufficiently traumatic to interfere with daily functioning or result in unrelenting distress. As a psychotherapist specializing in grief and loss, I have found EMDR (Eye Movement Desensitization and Reprocessing) to be an effective tool for alleviating trauma in grief. As in grief, trauma affects the whole person — body, mind and spirit, and on a hierarchy of needs, trauma must be dealt with in order for the healing process of grief to proceed in a healthy, and healing, fashion.

What is EMDR?

In brief, EMDR was developed by psychologist Francine Shapiro after making a chance discovery that the lateral movement of her eyes reduced the intensity of disturbing material she was dealing with in her life (Shapiro, 1995, p. 2). Dr. Shapiro spent several years scientifically studying this phenomenon, and found that bilateral stimulation, i.e., stimulation on both sides of the body — whether in the form of eye movements, tapping, sound or other forms — released traumatic material from the brain in a way that made the material workable. Trauma that is locked in the brain leads to the “fight, flight or freeze” response, and EMDR helps transform traumatic images into memories that no longer have a deleterious hold on the individual.

In addition to this physiological response to trauma, the traumatized individual often develops negative beliefs about him or herself (such as “I do not deserve love, “I was at fault” etc). The beauty of EMDR is that it works on a cognitive level as well as the physiological level, not only facilitating the transformation of traumatic images in the brain, but also allowing the individual to replace negative cognitions about him or herself with positive ones (such as “I deserve love”, “I did the best I could”, etc.). EMDR also works on a somatic level, with the therapist guiding the client to feel the traumatic images and negative beliefs in the body, thus further facilitating the transformation of the images into non-intrusive memories, and also transforming the negative beliefs into positive, useful ones. Therapists need to be trained to practice EMDR, and follow a standardized protocol in EMDR work with clients.

Case Studies

Two cases in my practice are illustrative of the effectiveness of EMDR in resolving traumatic grief. “Carol”, the mother of two small children, came to see me complaining of ongoing distress after the death of her husband nine months before. “Bill” was in a motorcycle accident, sustaining a broken leg. After being admitted to the hospital, Bill suffered a stroke and brain swelling, and died after being taken off life support two days later. Carol was concerned about her irritability, particularly toward her children, and her anger toward Bill for dying and leaving her with two small children to raise alone. She also expressed guilt regarding her anger toward Bill, which I spent time validating and normalizing, since anger is often exhibited as a normal grief response. Carol spent much time telling her story — a useful healing tool for making meaning of a seemingly senseless situation (White, 1995). She did not exhibit signs of trauma for the first few months that we worked together. However, as the anniversary of Bill’s death approached, Carol found it difficult to sleep, being awakened by intrusive images of Bill lying in the hospital bed and her shock when she learned of his condition. We explored Carol’s negative cognitions around these images and Bill’s sudden death. The negative belief that that most impacted Carol was her belief that Bill’s death was her fault because she had a premonition that he would be in an accident, and she did nothing to prevent it. In describing the images of Bill lying in the ICU and her belief that it was her fault, Carol felt tightness in her chest and had difficulty breathing. After two 90-minute EMDR sessions, Carol was able to replace her negative belief “I was at fault” with the positive belief “I did the best I could.” She reported that she still, of course, experienced memories of Bill’s death, and reported she was very pleased that that she could feel sadness without guilt. Carol was thus finally able to process her grief and loss in a healthy way.

My work with “Mary” was deeply profound and moving. Mary’s husband “Don” suffered with Lou Gehrig’s disease (ALS) for three years, and Mary witnessed the horrible, inexorable ravaging of Don’s body while his mind stayed strong. Mary’s expressed purpose for coming to see me was that she was unable to feel Don’s presence in her life. Mary described Don as her soul mate, and I assured her that because of the strength of their bond, she would find a place for Don in her heart and feel his presence as a support in order to move forward. However, it was clear that she would first have to deal with the traumatic images that prevented her from fulfilling this step in her grief process. The most disturbing image, and target for our EMDR work, was finding Don lying in a pool of blood on the bathroom floor after falling out of his wheelchair. I taught Mary the “butterfly” technique, in which the client crosses his or her arms across the chest in a hug and taps alternately below each shoulder, simulating the bilateral stimulation used in formal EMDR sessions. I instructed Mary to use this technique at home as a resource when traumatic images arose. After two sessions, with Mary working at home with the butterfly hug when disturbing images and emotions arose, Mary reported that those images had receded as mere memories that were no longer unduly disturbing.

Mary came into our next session glowing, and reported that she had felt a tug at the back of her shirt while sitting quietly one day and “knew it was Don, back in my life.” She reported that she subsequently felt Don’s presence coming to her every night before she fell asleep. Our trauma work was done, and Mary was well on the way to healing her grief.

Conclusion

My work with both Carol and Mary, as well as many others, has enhanced my confidence in my therapeutic skills in identifying and working with traumatic grief, and has increased my trust and faith in the effectiveness of EMDR as a healing tool in grief.